National health care spending continued its slow growth in 2010, according to a new report from the Department of Health and Human Services. The 3.9% increase was lower than the rise in gross domestic product of 4.2%, and a far cry from previous double-digit jumps in the 1980s and 1990s.
A Kaiser Health News article on the report notes that premiums for individuals in private health insurance plans grew by 2.4% in 2010, while insurers’ spending on actual benefits rose only 1.6%. That disparity has invited multiple interpretations of the data. The Centers for Medicare and Medicaid Services, for instance, thinks the recession is to blame: With more uninsureds and greater out-of-pocket costs, patients sought care less frequently.
Karen Ignagni, president of America’s Health Insurance Plans, sees it another way. The portion of premiums “allocated to health plans administrative costs was among the lowest in recent years, despite the fact that health plans have been incurring new compliance and regulatory costs related to the health care reform law,” she said.
Health care analyst Tom Miller of the American Enterprise Institute believes the spending trend is a positive sign. “We may have broken the old dynamic, where there’s an ingrained force that says we will spend more on health care than we do on other things,” he said.
Two items regarding a couple lesser-known Affordable Care Act provisions:
John Goodman’s Health Policy Blog reviews the status of Consumer Operated and Oriented Plans (CO-OPs), alternatives to existing health insurance options. Scheduled to take effect in 2014, CO-OPs allow for the creation of non-profit insurers via government loans, available to individuals and small business and run by their customers.
The Health Policy Blog highlights an Urban Institute “interim assessment” of CO-OPs, which lists the challenges the program faces based on its design. Among them: Insufficient time to build clients and provider networks, prohibition of using the loan funding for marketing and “propoganda", and restrictions on insurance industry and government involvement.
In addition to these limitations, sponsors have to jump through plenty of hoops to start up a CO-OP. According to the Urban Institute paper, applications for funding must include “a feasibility study, a detailed business plan, a detailed budget with narrative and a timeline for meeting various milestones, including the necessary state regulatory approvals” – tasks made all the more difficult when available expertise is narrowed to those currently outside insurance and government.
The Washington Post Wonkblog recently reported on the quiet demise of health care reform’s Consumer Assistance Program. Funds for the service, created to help state residents find affordable health insurance coverage, were halted when Congress couldn’t agree on a new federal budget.
The blog post highlighted the closing of the Texas program, which was given a $2.8 million grant and hired nine employees to staff a toll-free hotline. Before shutting down, more than 6,000 Texans used the service – which, as a follow-up post notes, works out to about $466 per call.
It’s a good news/bad news day for the makers and users of nicotine patches, which are designed to help people stop smoking:
WebMD reports that nicotine patches may actually improve the brain performance of people with mild memory loss, often an early warning sign of future dementia. A small study of senior adults, all showing signs of early memory loss, found that the group who wore 15-milligram patches were better able to pay attention and demonstrated better long-term memory than the group who were given a placebo.
“The patients improved enough that they noticed the difference,” says researcher Paul Newhouse, MD, a professor of psychiatry at Vanderbilt University School of Medicine. He also noted that nicotine appears to incrementally improve memory the longer the patches are used.
Researchers from Harvard School of Public Health and the University of Massachusetts had less pleasant news to announce: A “real world” study of people trying to kick the cigarette habit determined that nicotine patches and gum are no more effective in the long term than going cold turkey, Medical News Today reports.
Rather than relying on clinical studies, the research team tracked adult smokers trying to quit, surveying them multiple times over a six-year period. In each period analyzed, about one-third of quitters had taken up smoking again, and the odds of relapsing were equally great for those who had used nicotine replacement products as those who had not – even when the patches and gums were combined with professional counseling.
Teeth get all the glory, but it’s time to pay the gums a bit of respect as well. After all, they do all the heavy lifting that allow you to bite, nibble and when you’re upset, grind. And when your gums get infected, they may be sending signals that bigger problems lurk beneath the surface.
According to WebMD, nearly 75% have some form of periodontal disease, better known as gum disease. It can be caused by poor oral hygiene as well as tobacco use, stress, poor nutrition and many other factors.
Equally troubling as gum disease itself is the impact it may have on other medical conditions. Research has linked gum disease with heart disease, diabetes, lung problems, and premature and low-birth-weight babies.
The best defense against gum disease is taking care of your teeth through daily brushing and flossing. And two times a year, visit a dental professional who can help detect, prevent, and treat gum disease and the disorders that accompany it.
MedBen Dental incorporates affordable coverage, sound dental principles and responsiveness to the needs of your employees, in a plan that stresses regular check-ups and good dental hygiene. Every dentist can participate in the plan, so employees can continue to use their family dentist or any other dentist of their choice.
Employers can offer MedBen Dental benefits as a standard plan on a voluntary basis. To learn more, please call Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.
On Friday, the Obama administration submitted a 62-page filing with the Supreme Court defending the constitutionality of the individual mandate, ABC News reports.
In the filing, Solicitor General Donald B. Verrilli contends that the Affordable Care Act was passed to address the national crisis that has arisen from shifting the health care costs of the insured to other market participants. “The Act breaks this cycle through a comprehensive framework of economic regulation and incentives that will improve the functioning of the national market for health care by regulating the terms on which insurance is offered, controlling costs, and rationalizing the timing and method of payment for health care services,” Verrilli writes.
Verrilli also argues that requiring most Americans to buy health insurance by 2014 or pay a fine will help “to expand the availability and affordability of health insurance coverage.”
As to challengers’ claims that the Commerce Clause of the Constitution does not give Congress the authority to force someone to buy a product, Verrilli counters that everyone will need health care at some point in his or her life, and that the individual mandate offers a viable method to fund that care.
Getting a flu shot is a good thing – we’ve said as much on this blog. But immunization is only half the battle in preventing a bout with the bug.
Speaking to Medical Xpress, primary care physician Sri Murthy, MD says avoiding illness begins with a sink, hot water and soap. “Washing your hands before eating, during food preparation, after bathroom use, after touching surfaces in common areas and/or after blowing your nose or sneezing greatly reduces the amount of germs on your hands and prevents the spread of illness.”
Murthy notes that cold weather keeps us indoors at home and work, making us more vulnerable to germs carried in the “stale, warm air.” Furthermore, because many of us eat meals or snacks at our desk, our workstations may be teeming with illness-causing germs. A University of Arizona study found the typical worker’s desk has hundreds of times more bacteria per square inch than an office toilet seat. (We know, eww.)
“These findings are disturbing, but by practicing simple office hygiene – like washing your hands, cleaning your desk with antibacterial cleaner weekly, properly washing any reusable eating utensils, and finally, getting out of the office every once in awhile for lunch or just for a quick walk – can help,” Murthy says. In fact, a regular exercise regimen can bolster the immune system, she adds.
We’ll get the bad news out of the way first. Cancer is still the second-leading cause of death behind heart disease. And the incidents of some forms of cancer, including skin, liver and kidney, are actually on the rise.
But the American Cancer Society does have some positive news to offer. A new report concludes that overall cancer death rates have dropped through 2008, continuing a nearly 20-year-long trend. That means over one million Americans who would have been expected to die from the disease did not, according to WebMD.
The declines, the ACS report found, were due in large part to decreases in lung cancers in men and breast cancers in women. A greater emphasis on cancer screenings have contributed, said Michael V. Seiden, MD, PhD, president and CEO of Fox Chase Cancer Center. He did note, however, that the numbers could and should be better.
“The colonoscopy screening rates are nowhere where they should be, but they are slowly creeping up. The mammography screening rates are better as compared to a decade ago,” Seiden said.
MedBen Worksite Wellness recommends regular colonoscopy and mammography screenings, based on age and gender. The program also stresses the importance of an annual wellness exam, as well as testing for cholesterol, PSA and pap smear. Practicing timely preventive care greatly improves the chance a cancer or other disease can be detected and treated successfully.
Worksite Wellness members can check their compliance with critical wellness examinations by visiting the MedBen Access website and clicking on the Wellness Plan link under “My Plan”.
The Obama adminstration appears to have the momentum going into the Supreme Court case over the individual mandate, seeing how they’ve got a winning record in federal appeals courts. But throughout the legal process, the administration hasn’t adequately answered one question: If Congress has the constitutional power to make almost every American buy health insurance, where does that power stop? The Hill website reviews several judicial perspectives on the issue.
The 11th Circuit Court of Appeals struck down the individual mandate in part because the administration didn’t address the limits of regulartory power. “Ultimately, the government’s struggle to articulate… limiting principles only reiterates the conclusion we reach today: There are none,” the court said in its ruling.
Conversely, the U.S. Circuit Court for the District of Columbia upheld the mandate, while acknowledging in its opinion “some discomfort with the government’s failure to advance any clear doctrinal principles limiting congressional mandates that any American purchase any product or service in interstate commerce.”
In lower courts, the Justice Department contended that health care is different from other forms of commerce. As hospitals must treats all patient regardless of their ability to pay, the system incurs unpaid bills, which are ultimately passed on to insured people and the government. No other product, they claimed, involves the same type of cost-shifting.
That argument doesn’t sufficiently address the issue, said Ilya Shapiro, a legal scholar at Cato Institute. “The DOJ has to do a better job of answering, ‘What goes beyond your theory of federal power?’ They’ve been asked this in every court and they’ve never satisfied the court, even in the cases they’ve won.”
It should come as no surprise that health club memberships go way up in January: some gyms see enrollments spike as much as 50%. And competing clubs are happy to offer incentives to draw in New Year’s resolutioners, such as free initiations and lower monthly fees.
But while joining a gym can pay off in better health, it can also be a pricey proposition if you’re not careful. Men’s Health (via MSNBC.com) offers some tips to avoid new member gimmicks, we which summarize below:
One additional suggestion: check with your employer before beginning a gym search. Many businesses – MedBen among them – have negotiated discounts with local fitness clubs. And you may be able to enroll (and cancel) directly through your human resources department, saving you a bit of hassle.
Recent research by eHealth demonstrates how unhealthy habits can hurt the pocketbook as well as the body. As the results from this Smoking Status and BMI study show, average monthly premiums paid for individual health insurance are negatively impacted by cigarettes and improper diet (via Stone Hearth News):
On the group insurance level, such disparities are not as readily apparent, but unhealthy habits certainly do affect overall health care costs. At MedBen, we encourage our plan members, regardless of their current health status, to start off 2012 on the right foot with a visit to their family doctor. And if you’ve been meaning to kick the cigarette habit or lose that spare tire, there’s no better time than now.
The Pharmalot blog reports that when it comes to generic drugs, bigger is definitely not better. The FDA has put several drugmakers on notice that their drug applications will not be approved until the tablet size is more in line with the brand-name drug, citing safety and efficacy problems for patients.
A letter to one manufacturer reads: “The larger tablet size poses greater potential safety issues such as choking, tablet arrest and prolonged transit time, which could result in esophageal injury and/or pain. The larger tablet size also raises product efficacy concerns due to patients’ inability or unwillingness to swallow the larger tablets… Therefore, from a clinical standpoint, this product is unacceptable for approval as a generic and we recommend that you redesign your product to be closer in size to the relevant strengths” of the brand-name medicine.
As blog writer Ed Silverman points out, however, the FDA failed to provide “any guidance to the companies about acceptable differences in size” – as in, exactly how big is too big? Moreover, does this action reflect a more sweeping policy that will affect existing tablets as well?
If the agency does introduce across-the-board size restrictions, it could possibly require a bigger investment by the drugmakers – costs that could potentially be passed onto the patient. Of course, this is merely speculation at this point.
HealthDay recently posed the question, “Is American medicine too test happy?” According to the article, doctors are wondering the same thing, based on a growing body of evidence that overuse of diagnostic testing – say, a blood test followed by an ultrasound, topped off by an electrocardiogram – may be harming patients’ health and driving up health care costs.
“There is clear overuse or misuse of certain kinds of tests for certain patients,” said Dr. Steven E. Weinberger, executive vice president and chief executive officer of the American College of Physicians. Weinberger and Dr. Anthony Shih, executive vice president for programs of the Commonwealth Fund, identified three primary risks associated with diagnotic testing:
As for the cost factor, some experts estimate that excessive testing wastes upwards of $250 billion a year – an amount equal to about 10% of the total amount spent on the nation’s health care.
But acknowledging the need for restraint begs another question: Who is responsible for keeping testing in check – the doctor or the patient? Weinberger thinks both play an important role. “There needs to be an honest conversation in both directions, with a clear understanding about what is and isn’t necessary,” he said.
MedBen encourages its plan members to discuss pending diagnostic tests with their physicians, in order to better understand their purposes and potential risks. The Cleveland Clinic offers several lists of questions to ask your doctor, ranging from symptoms and diagnosis to treatment and surgery.
Ohio, Michigan and Illinois are among 23 states that have been awarded nearly $300 million for providing health coverage for children, Reuters reports (via Yahoo! Health).
States qualified for the bonuses by adapting procedures that make it easier to enroll and retain coverage under the Children’s Health Insurance Program (CHIP), a program that provides matching funds to states for health insurance to families with children. Administered by the Department of Health and Human Services, CHIP was created to cover uninsured children in families with incomes that are modest but too high to qualify for the Medicaid program.
Qualifying states also had to exceed the enrollment target set by Medicaid for low-income Americans and facilitate children’s enrollment in that program as well.
Enrollment in CHIP has risen by 1.2 million since 2009, according to the Centers for Disease Control and Prevention.
Two new studies offer a cautionary note for those of us who are seldom found without an MP3 player and a pair of earbuds:
HealthDay reports that about 90% of New York City residents may be at risk of hearing loss due to noise exposure. And while the din of subways and other transit modes contribute to the decline, MP3 players appear to play the greatest role nowadays.
The researchers gathered information based solely on information about work and leisure activities volunteered by participants, so the study is far from conclusive. But lead author Richard Neitzel of the University of Michigan said the findings suggest that auditory dangers are prevalent in the urban environment. “We need to step up our efforts to encourage people to protect their hearing,” he advised, and added that medical professionals need to “do a better job educating people that listening to music, if it’s loud enough, can hurt you.”
According to Medical News Today, one in four teens is in danger of early hearing loss as a result of listing to MP3 players at high volumes. Researchers at Tel Aviv University studied teens’ music listening habits and took acoustic measurements of preferred listening levels. Based on their findings, they theorize that teens misusing personal listening devices (PLDs) today could experience signs of hearing loss as earlier as their 30’s.
“In 10 or 20 years it will be too late to realize that an entire generation of young people is suffering from hearing problems much earlier than expected from natural aging,” says Prof. Chava Muchnik of TAU’s Department of Communication Disorders. She recommends that PLD manufacturers adopt the European standards that limit their output of to 100 decibels.
Last month, the Obama administration announced that states will have greater flexibility to determine benefits available through their health insurance exchanges under the Affordable Care Act. But just how much latitude will the federal government allow? Stateline provides some clarification:
“Not total freedom, by any means. The national health law lists 10 categories of health care that all insurance policies must cover: hospitalization, emergency care, out-patient services, maternity and newborn care, mental health and substance abuse services, prescription drugs, laboratory testing, preventive and wellness care, pediatric services (including dental and vision examinations), rehabilitative care and habilitative care such as services for children with developmental disabilities.
“But within those categories, the federal government is allowing each state to determine its own basket of essential benefits by choosing a ‘benchmark’ package offered by any of a variety of insurers. They can pick from:
“If a state does not select any of these, the largest plan in the small group market will be the default. If a state selects a benchmark which does not cover one or more of the 10 required categories, it would need to ’supplement’ the benchmark to include all 10.”
So, we’re three days into the new year… have you stuck with that resolution to lose weight?
Well, now is not the time to get discouraged… rather, accept the reality that setbacks are inevitable when changing long-held dietary behaviors, said Dr. Jessica Bartfield, an internal medicine and medical weight-loss specialist at Gottlieb Memorial Hospital. “When you learn to ride a bike, you expect that you will fall down a couple times and are prepared to try again and get back on; you need to have the same expectation with weight loss and to plan accordingly,” she explained.
Barfield offered suggestions to help you achieve and maintain your weight loss goals, several of which we highlight below. You can find all the tips at HealthDay News (via Yahoo! Health).
A recent survey by the Pharmacy Benefit Management Institute found more employers offer prescription plans that reduce the price of generic drugs while asking employees to pay a greater share of the cost for brand name medications. Employee Benefit News reports that four-tier prescription plans are proving particularly popular.
According to PBMI, four-tier Rx plans have seen a spike in usage in the past year, with about a quarter of surveyed employers now offering the design. Such plans offer increasing copays for generic and brand name medications in the bottom three tiers, while the 4th tier is reserved for higher-cost specialty medicines available to patients at a discounted rate.
MedBen has the capacity to offer a four-tier prescription plan design – and in a certain sense, we already do. Many of our self-funded groups now offer a special level for prescribed over-the-counter medications, available at little or no cost to the employee, in addition to existing generic and brand tiers.
But our experience shows that the benefits of a extra “specialty” tier can be equally achieved through the use of a three-tier plan with a percentage copay for Tier 2 and Tier 3 medicines, with or without maximum copayments per Rx claims. Such three-tier plans are most effective in conjunction with a well-designed drug formulary program, says Allan Zaenger, President and CEO of Pharmaceutical Horizons, which provides financial and plan management consultation to MedBen and its clients.
“A four-tier plan can be administratively cumbersome for both the plan sponsor and claims processor, who have to maintain a list of specialty medicines which changes with some frequency as the FDA approves medicines throughout the year,” Zaenger notes. “It also requires a common understanding of what the definition of a ’specialty drug’ is and how frequently the list is to be updated.”
MedBen clients with questions regarding their drug plan may contact their group service representative.
USA Today reviews the major health care changes that took effect in 2011 as a result of the Affordable Care Act. Those that directly impact group health plans, such as preventive health benefits paid in full and continued coverage for dependents until age 26, were actually introduced in 2010, but didn’t affect most employers until this year.
A summary of the five biggest changes brought on by the health care reform law this year:
A crackdown on fraud. In 2011, the federal government prosecuted 1,235 fraud cases – up 69% from the previous year – and, according to Vice President Biden, recovered $2.9 billion in ill-gotten health care funds.
Relief for those 25 and younger. Young adults up to age 26 can stay on their parents’ health insurance policies, including married ones. About 2.5 million young adults have taken advantage of this provision, designed to get healthier individuals in insurance pools.
More benefits for senior citizens. Free preventive care screenings and a closing of the presciption drug “donut hole” are among the benefits introduced to seniors in 2011.
Preventive care services for the privately insured. Insured patients can now receive annual exams, immunizations and screenings at no cost. Many insurance plans had already covered these services at 100% (or for a small co-pay), but additional “essential health benefits” to be introduced in 2014 will likely impact patient premiums.
Insurance for those with pre-existing conditions. Americans with high-risk conditions who have lacked health insurance for at least six months can join the government’s Pre-existing Condition Insurance Plan. Enrollment has been slow, with only about 41,000 people joining in its first 12 months.
We’re guessing that a couple of you reading this will bring in the new year by consuming an adult beverage of your choosing. (We, being devoted to all things healthy, will of course toast the occasion with sparkling apple cider.)
New Year’s Eve parties offer ample opportunities to imbibe. But by practicing some self-control during the festivities and afterward, you can start 2012 without a hangover. Dr. Aaron Michelfelder, a Loyola University Health System family physician, offers these tips (via Medical Xpress):
Before the party:
During the party:
After the party:
The morning after:
What doesn’t work:
From proprietary claims surveillance to wellness and precertification programs, MedBen uses a variety of cutting-edge methods to help contain your plan’s health plan costs. To complement these savings strategies, we now offer, as an optional benefit, comprehensive care management through Accountable Care Solutions. These programs were designed by medical professionals to control chronic condition expenses – arguably the single greatest challenge to keeping health care costs down.
Accountable Care Solutions employ comprehensive care management employs specialty physicians to provide peer-to-peer consultation before care is delivered. This ensures that your employees and their covered dependents receive the correct treatment, which results in the appropriate quality and cost of care while promoting positive patient outcomes.
MedBen offers comprehensive care management for three costly and pervasive chronic conditions: Oncology, Cardiovascular and Kidney Care. We provide these programs through inVentiv Medical Management (formerly known as AWAC), a leader in medical management.
Care management does not and will not overrule the decisions of a patient’s physician. It merely works with the doctor to ensure that the patient is receiving the proper level of treatment, and that his or her care is eligible for coverage under the company’s health care plan.
The three comprehensive care management programs are available as a package or can be purchased individually. For additional information about Accountable Care Solutions, contact MedBen Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.